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Unusual case of parkes-weber syndrome in a patient with spontaneous subarachnoid hemorrhage 自发性蛛网膜下腔出血的帕克-韦伯综合征的罕见病例
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230128027i
Jovan Ilic, Aleksandar Kostić, Vesna Nikolov, Marija Djordjević, M. Radisavljevic, Boban Jelenkovic, N. Stojanovic, Aleksandra Aracki-Trenkic
Introduction. Parkes-Weber syndrome (PWS) is a complex and rare genetic disease of combined vascular malformations that primarily occur in the extremities and can involve the pelvic blood vessels. In extremely rare cases, the disease is manifested by endocranial and spinal involvement, while the treatment of such patients represents a challenge for neurosurgical centers and requires multidisciplinary approach. Case report. We present the case of a 46-year-old male patient who was admitted to the emergency department due to spontaneous subarachnoid hemorrhage (SAH), moderate flaccid paraparesis and urinary incontinence. Furthermore, the patient was previously diagnosed with PWS, while the genetic evaluation proved the RASA1 gene mutation. He experienced a spontaneous SAH and was hospitalized 26 years ago, while 6 years ago he underwent a right nephrectomy due to multiple hilar aneurysms of the right renal artery and its branches. Digital subtraction angiography of the endocranium was performed, which detected no aneurysmal dilatations or arteriovenous malformations (AVM). The magnetic resonance imaging recorded spinal intradural AVM in the vertebral levels between T12 and L3, which completely filled the dural sac. After the conservative treatment, there was a significant improvement in the patient's neurological and clinical condition. Conclusion. To the best of our knowledge, this is the only case report of a patient with PWS who had a spinal intradural AVM and spontaneous SAH without high-output heart failure, with a history of a previous nephrectomy.
介绍。帕克斯-韦伯综合征(PWS)是一种复杂而罕见的遗传性血管性畸形,主要发生在四肢,可累及骨盆血管。在极其罕见的病例中,疾病表现为颅内和脊柱受累,而这类患者的治疗对神经外科中心来说是一个挑战,需要多学科的方法。病例报告。我们报告一名46岁男性病患,因自发性蛛网膜下腔出血(SAH)、中度弛缓性截瘫及尿失禁而入院急诊科。此外,患者之前被诊断为PWS,而遗传评估证实了RASA1基因突变。26年前,他经历了自发性SAH,住院治疗,6年前,由于右肾动脉及其分支的多发门动脉瘤,他接受了右肾切除术。颅内数字减影血管造影未发现动脉瘤扩张或动静脉畸形(AVM)。磁共振成像显示脊髓硬膜内AVM位于T12和L3之间的椎体水平,完全填充硬膜囊。经保守治疗后,患者的神经系统及临床状况均有明显改善。结论。据我们所知,这是唯一一例有脊髓硬膜内AVM和自发性SAH的PWS患者,无高输出量心力衰竭,既往有肾切除术史。
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引用次数: 0
Myocarditis as the first manifestation of eosinophilic granulomatosis with polyangiitis 心肌炎是嗜酸性肉芽肿病合并多血管炎的首要表现
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230218026d
D. Djordjević-Radojković, S. Apostolovic, Miodrag R Damjanović, T. Kostić, Aleksandra Fejsa-Levakov, Marko A. Dimitrijevic, R. Janković-Tomašević, S. Dakić, N. Bozinovic, Milena Pavicevic
Introduction. Myocarditis is a common diagnosis, but its etiology often remains unknown as it requires extensive diagnostic work. Eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome is a very rare systemic disease, which is not easy to diagnose. Myocarditis in EGPA is not common and it usually occurs in the late stages of the disease. Case report. A 22-year-old man was admitted as acute coronary syndrome (ACS). Coronary angiography was performed and excluded stenosis of epicardial coronary arteries. The working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) was established. Then we found inflammatory syndrome, eosinophilia and a lot of systemic symptoms and signs. We managed to establish the diagnosis of myopericarditis by cardiac magnetic resonance imaging (MRI). The diagnostic workout included extensive laboratory tests, which ruled out infectious agents. Then, immunological tests, a computed tomography (CT) scan of the chest, and a biopsy of the bone marrow, nasal mucosa, and skin were performed. The cause of myocarditis - EGPA, was found only after the histopathological finding of the skin biopsy, which enabled adequate immunosuppressive therapy. Conclusion. The accurate diagnosis was crucial for the correct-causal treatment of the patient, especially since he needs life-long immunosuppressive therapy. For such complex patients, a multidisciplinary approach and perseverance in the diagnostic evaluation of the etiology of myocarditis are necessary for adequate treatment.
介绍。心肌炎是一种常见的诊断,但其病因往往仍不清楚,因为它需要广泛的诊断工作。嗜酸性肉芽肿病合并多血管炎(EGPA)或Churg-Strauss综合征是一种非常罕见的全身性疾病,不易诊断。EGPA心肌炎并不常见,通常发生在疾病的晚期。病例报告。一名22岁男性因急性冠状动脉综合征(ACS)入院。行冠状动脉造影,排除心外膜冠状动脉狭窄。建立了非阻塞性冠状动脉心肌梗死(MINOCA)的工作诊断。然后我们发现了炎症综合征,嗜酸性粒细胞增多和许多全身症状和体征。我们设法通过心脏磁共振成像(MRI)建立心肌炎的诊断。诊断训练包括广泛的实验室测试,排除了传染性病原体。然后,进行免疫学检查、胸部计算机断层扫描(CT)、骨髓、鼻黏膜和皮肤活检。心肌炎的病因- EGPA,只有在皮肤活检的组织病理学发现后才被发现,这使得免疫抑制治疗成为可能。结论。准确的诊断对于患者的正确病因治疗至关重要,特别是因为他需要终身免疫抑制治疗。对于这种复杂的患者,多学科的方法和坚持诊断评估心肌炎的病因是必要的充分治疗。
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引用次数: 0
Nutrition in COVID-19 recovery COVID-19恢复中的营养
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230512041r
Vesna Rudic-Grujic, Nina Rodić-Vukmir, Mirjana Djermanovic
nema
nema
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引用次数: 0
Urinary tract infections in children with cancer and febrile neutropenia - single center experience 儿童癌症伴发热性中性粒细胞减少的尿路感染-单中心经验
4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230620057k
Natasa Kovac, Maja Samardzic-Lukic, Natasa Kacanski, Aleksandra Kovac, Tijana Latinovic, Jovanka Kolarovic
Background/Aim. Urinary tract infections (UTI) in children with febrile neutropenia (FN) after receiving chemotherapy could be followed by atypical symptoms and signs of UTI. Absence of routine sampling of urine culture for analysis could lead to undiagnosed disease and inadequate treatment of these patients. The aim of the study was to indicate the importance of sampling of urinoculture in children who have developed febrile neutropenia and to point out the most probable causative agents of UTI in children with FN and antibiotic sensitivity/resistance of the isolated strains. Methods. During a five-year observation period, 40 UTIs were registered in 30 patients with FN. In the study group of patients with FN the number of UTI, the number of recurrent UTI, isolated pathogens, their sensitivity to antibiotics, characteristics of urine sediment, the presence of localized symptoms of urinary tract infection and presence of urosepsis were analyzed. The obtained results were compared with the control group which consisted of children who were healthy prior to hospitalization due to febrile urinary infection. Results. When compared to the control group, significant differences in the presence of symptoms of urinary tract infection and urine sediment findings in patients with febrile neutropenia were observed. Higher percentage of resistant strains of Escherichia coli were isolated from urine culture of cancer patients with FN was noted when compared to the control group. Three UTI cases were followed by urosepsis. Conclusion. Urine culture findings are important not only in establishing the diagnosis of UTI and detecting multi-resistant bacterial strains, but also in appropriate antibiotic choice and selecting subgroup of patients with recurrent UTI who require further monitoring and detecting potential complications in a timely manner.
背景/目的。发热性中性粒细胞减少症(FN)患儿接受化疗后可出现尿路感染(UTI)的不典型症状和体征。缺乏常规尿液培养样本进行分析可能导致未确诊的疾病和这些患者的治疗不足。该研究的目的是表明对患有发热性中性粒细胞减少症的儿童进行尿液培养取样的重要性,并指出FN患儿中最可能的尿路感染病原体和分离菌株的抗生素敏感性/耐药性。方法。在5年的观察期内,在30例FN患者中登记了40例uti。分析研究组FN患者尿路感染数量、复发尿路感染数量、分离病原菌及其对抗生素的敏感性、尿沉积物特征、尿路感染局部症状的存在及尿脓毒症的存在。将所得结果与因发热性尿路感染住院前健康儿童组成的对照组进行比较。结果。与对照组相比,观察到发热性中性粒细胞减少患者在尿路感染症状和尿沉积物发现方面存在显著差异。与对照组相比,FN癌症患者尿液培养中分离出的耐药大肠杆菌比例较高。3例尿路感染后并发尿脓毒症。结论。尿培养结果不仅对建立尿路感染的诊断和发现多耐药菌株具有重要意义,而且对合理选择抗生素和选择复发性尿路感染患者亚组进行进一步监测和及时发现潜在并发症具有重要意义。
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引用次数: 0
RNA vaccines: A milestone toward a new era RNA疫苗:迈向新时代的里程碑
4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp2310811j
Srdja Jankovic
nema
尼玛
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引用次数: 0
Does hospital medical staff maintain hospital disaster resilience? 医院医务人员是否保持医院的抗灾能力?
4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230727067g
Mariya Georgieva, Rostislav Kostadinov, Mariya Semerdjieva-Filipova
Background/Aim. In case of a disaster, it is necessary for the medical personnel to demonstrate the operational component of disaster resilience, which requires certain knowledge and skills regarding disaster medical response algorithms. The aim of this study was to analyze the preparedness of hospital medical professionals for maintaining hospital disaster resilience. Methods. In the period from July to September 2019, an anonymous survey was conducted among 295 hospital medical staff employed in hospitals in the territory of the region of Plovdiv, Bulgaria. Pearson's chi-square test, Student's t-test and graphical analysis were used in the statistical analysis. Results. of the survey show that most of medical staff (85.8%) believed that disaster drills are not held regularly in hospitals, the training period was less than 2 years (30.8%), and that the majority (86.1%) did not participate in exercises. Conclusion. The level of preparedness for responding to disasters is not maintained at a high level in hospitals in the territory of the Plovdiv region due to the irregular implementation of exercises and the small number of participants in them. So, it is necessary to introduce a specific training program and exercise once a year, which should have a beneficial effect on increasing the better preparedness of the medical staff for disasters and improving the operational resilience of the hospital.
背景/目的。在发生灾害的情况下,医务人员有必要展示抗灾能力的业务部分,这需要有关灾害医疗应对算法的某些知识和技能。本研究的目的是分析医院医疗专业人员对维持医院抗灾能力的准备情况。方法。在2019年7月至9月期间,对保加利亚普罗夫迪夫地区医院雇用的295名医院医务人员进行了一项匿名调查。统计学分析采用Pearson卡方检验、Student’st检验和图形分析。结果。调查显示,大多数医务人员(85.8%)认为医院没有定期举行灾害演习,训练期不足2年(30.8%),大多数医务人员(86.1%)认为没有参加演习。结论。在普罗夫迪夫地区境内的医院,由于演习不定期进行,而且参加演习的人数很少,救灾准备水平没有保持在高水平。因此,有必要引入具体的培训方案,每年进行一次演练,这应该对提高医务人员对灾害的准备能力和提高医院的业务弹性有有益的作用。
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引用次数: 0
Use of lung ultrasound in the differential diagnosis of causes of dyspnea 肺超声在呼吸困难病因鉴别诊断中的应用
4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230905053b
Kristina Bulatovic, Andjelka Ristic-Andjelkov, Vladan Peric, Jovana Todorovic, Milena Pandrc, Gabrijela Gojka, Danijela Vranes, Maja Sipic, Dragisa Rasic, Aleksandra Milenkovic, Jelena Aritonovic-Pribakovic, Milica Peric
Background/Aim. The area of lung ultrasonography is fast developing and it provides the medical community with numerous new diagnostic opportunities. The aim of this study was to examine the etiology of dyspnea on admission and to assess the stage of heart failure (HF) according to the ultrasound examination of the heart and lungs on admission. Methods. The cross-sectional study included total of 110 patients treated with the symptoms of dyspnea. The study included all patients treated for any heart or pulmonary condition, as well as patients who reported the first episode of dyspnea without any previous illness. The most important diagnostic sign in the ultrasound of the lungs in HF is the appearance of B lines or comets, which indicate the accumulation of fluid in the interstitium of the lungs. Results. The mean number of registered comets was 14.2?7.4 (minimum 2, maximum 30). The mean number of comets among patients with HF was 18.8?5.9. The mean number of comets among patients without HF was 8.0?3.7, p<0.001. Multivariate linear regression analyses showed the association between the number of comets and HF group (p<0.001). Conclusion. As the assessment of pulmonary comets is safe and non-invasive it can easily be integrated in the daily clinical practice because it has been shown that the number of ultrasound pulmonary comets is significantly higher in patients with HF compared to those with dyspnea of other etiologies.
背景/目的。肺超声检查领域发展迅速,为医学界提供了许多新的诊断机会。本研究的目的是检查入院时呼吸困难的病因,并根据入院时心肺超声检查评估心力衰竭(HF)的分期。方法。横断面研究共纳入110例有呼吸困难症状的患者。该研究包括所有接受过任何心脏或肺部疾病治疗的患者,以及报告首次出现呼吸困难而没有任何既往疾病的患者。心衰肺超声最重要的诊断征象是B线或彗星的出现,这表明肺间质中积液。结果。平均登记的彗星数为14.2 ~ 7.4颗(最少2颗,最多30颗)。HF患者平均彗星数为18.8 ~ 5.9颗。无HF患者的平均彗星数为8.0 ~ 3.7,p < 0.001。多元线性回归分析显示彗星数量与HF组之间存在相关性(p<0.001)。结论。由于肺慧星的评估是安全且无创的,因此可以很容易地整合到日常临床实践中,因为已有研究表明HF患者超声肺慧星的数量明显高于其他病因的呼吸困难患者。
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引用次数: 0
Analgesic effect of pericapsular nerve group block on elderly patients undergoing hip replacement 囊包神经群阻滞对老年髋关节置换术患者的镇痛作用
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp220429002z
Min Zhou, Qiu-na Xu, Dong Zuo, Zhiyi Wang, Maohua Zhang, Tingting Liu, R. Liu
Background/Aim. Pericapsular nerve group block (PNGB) does not affect the motor nerve while blocking obturator and femoral nerves. The aim of study was to determine the application value of PNGB for elderly hip replacement. Methods. Ninety elderly patients undergoing hip replacement from March 2019 to October 2020 were randomly divided into fascia iliaca compartment block (FICB) and PNGB groups. FICB and PNGB were performed prior to subarachnoid block (SAB), respectively. Their baseline data, operation conditions, incidence of adverse reactions, visual analogue scale (VAS) score, heart rate (HR), mean arterial pressure (MAP), plasma cortisol (COR) and epinephrine (E) were compared. Results. VAS score, E and COR levels in PNGB group were lower than those in FICB group at time points T2-T4 (T2: 10 min after nerve block; T3: at position changing; T4: after position changing) (p<0.001). There were no significant differences in HR and MAP between the two groups at any time point (p >0.05). In PNGB group, the ultrasonic imaging time was shorter, the time point of pressing patient-controlled analgesia (PCA) for the first time was later, and the numbers of pressing PCA were fewer than those of FICB group (p <0.001). No local anesthetic poisoning occurred after nerve block, and no hematoma at the puncture site, nerve injury, nausea and vomiting, dizziness and delirium were found.Conclusion. Both FICB and PNGB prior to Swere highly safe for elderly hip replacement, but PNGB has shorter ultrasonic imaging time, better analgesic effect and milder oxidative stress, so it is worth applicating it clinically.
背景/目的。囊周神经群阻滞(PNGB)在阻滞闭孔神经和股神经的同时不影响运动神经。本研究旨在探讨PNGB在老年髋关节置换术中的应用价值。方法。将2019年3月至2020年10月行髋关节置换术的老年患者90例随机分为髂筋膜隔室阻滞组(FICB)和PNGB组。在蛛网膜下腔阻滞(SAB)之前分别进行FICB和PNGB。比较两组患者的基线资料、手术情况、不良反应发生率、视觉模拟评分(VAS)、心率(HR)、平均动脉压(MAP)、血浆皮质醇(COR)、肾上腺素(E)。结果。PNGB组患者在T2 ~ t4时间点VAS评分、E、COR水平均低于FICB组(T2:神经阻滞后10 min;T3:换位时;T4:换位后)(p0.05)。PNGB组超声显像时间较短,首次按压患者自控镇痛(PCA)时间点较晚,按压PCA次数少于FICB组(p <0.001)。神经阻滞后未发生局麻中毒,无穿刺部位血肿、神经损伤、恶心呕吐、头晕谵妄。s5之前的FICB和PNGB用于老年髋关节置换术都是高度安全的,但PNGB超声成像时间更短,镇痛效果更好,氧化应激更轻,值得临床推广应用。
{"title":"Analgesic effect of pericapsular nerve group block on elderly patients undergoing hip replacement","authors":"Min Zhou, Qiu-na Xu, Dong Zuo, Zhiyi Wang, Maohua Zhang, Tingting Liu, R. Liu","doi":"10.2298/vsp220429002z","DOIUrl":"https://doi.org/10.2298/vsp220429002z","url":null,"abstract":"Background/Aim. Pericapsular nerve group block (PNGB) does not affect the motor nerve while blocking obturator and femoral nerves. The aim of study was to determine the application value of PNGB for elderly hip replacement. Methods. Ninety elderly patients undergoing hip replacement from March 2019 to October 2020 were randomly divided into fascia iliaca compartment block (FICB) and PNGB groups. FICB and PNGB were performed prior to subarachnoid block (SAB), respectively. Their baseline data, operation conditions, incidence of adverse reactions, visual analogue scale (VAS) score, heart rate (HR), mean arterial pressure (MAP), plasma cortisol (COR) and epinephrine (E) were compared. Results. VAS score, E and COR levels in PNGB group were lower than those in FICB group at time points T2-T4 (T2: 10 min after nerve block; T3: at position changing; T4: after position changing) (p<0.001). There were no significant differences in HR and MAP between the two groups at any time point (p >0.05). In PNGB group, the ultrasonic imaging time was shorter, the time point of pressing patient-controlled analgesia (PCA) for the first time was later, and the numbers of pressing PCA were fewer than those of FICB group (p <0.001). No local anesthetic poisoning occurred after nerve block, and no hematoma at the puncture site, nerve injury, nausea and vomiting, dizziness and delirium were found.Conclusion. Both FICB and PNGB prior to Swere highly safe for elderly hip replacement, but PNGB has shorter ultrasonic imaging time, better analgesic effect and milder oxidative stress, so it is worth applicating it clinically.","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68338745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Organ preservation surgery for laryngeal cancer in a brass instrument player: A case report 铜管乐器演奏者喉癌器官保存手术一例报告
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230622039c
Ognjen Čukić, Aleksandar Milenkovic, J. Sotirović, M. Milojević
Introduction. Modern treatments for early glottic carcinoma achieve high rates of local control and long-term survival, but side effects can have a substantial impact on a patient's quality of life. Little available research is present on the effects of organ-preservation therapy in musicians, highlighting the challenge of balancing functional outcomes with occupational demands. Case report. We present the successful surgical treatment of a mid-membranous left vocal fold squamous cell carcinoma (T1a) in a professional trombonist with a history of smoking. Due to suboptimal exposure during initial microlaryngoscopy, open cordectomy was performed for tumor removal instead of transoral laser microsurgery. After the operation and the proper rehabilitation the patient continued to play the brass instrument unhindered and managed to fulfill all the requirements of a national orchestra. Conclusion. Selecting treatment for glottic cancers in professional brass instrument players remains challenging due to limited literature and potential harm to performance and career. Partial open laryngectomies for laryngeal cancer treatment are shown to be feasible without compromising performance.
介绍。对早期声门癌的现代治疗可以达到较高的局部控制率和长期生存率,但副作用会对患者的生活质量产生重大影响。目前很少有关于音乐家器官保存治疗效果的研究,强调了平衡功能结果与职业需求的挑战。病例报告。我们报告一个有吸烟史的专业长号手成功的手术治疗左声带中膜鳞状细胞癌(T1a)。由于初次喉镜检查时暴露不佳,我们采用开放性喉腺切除术来代替经口激光显微手术。手术和适当的康复后,病人继续无阻碍地演奏铜管乐器,并设法满足一个国家管弦乐队的所有要求。结论。选择治疗专业铜管乐器演奏者声门癌的方法仍然具有挑战性,因为文献有限,而且对演奏和职业生涯有潜在的危害。部分开放性喉癌切除术是可行的治疗喉癌不影响性能。
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引用次数: 0
Possibilities of stroke care improvement in Serbia: Consensus document for the prevention, treatment and rehabilitation of stroke in Serbia 塞尔维亚卒中护理改善的可能性:塞尔维亚卒中预防、治疗和康复的共识文件
IF 0.2 4区 医学 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-01-01 DOI: 10.2298/vsp230325040p
Viktor Pasovski, T. Novakovic, M. Parker, Katarina Katanic-Pasovski, R. Raičević
nema
{"title":"Possibilities of stroke care improvement in Serbia: Consensus document for the prevention, treatment and rehabilitation of stroke in Serbia","authors":"Viktor Pasovski, T. Novakovic, M. Parker, Katarina Katanic-Pasovski, R. Raičević","doi":"10.2298/vsp230325040p","DOIUrl":"https://doi.org/10.2298/vsp230325040p","url":null,"abstract":"<jats:p>nema</jats:p>","PeriodicalId":23531,"journal":{"name":"Vojnosanitetski pregled","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68341112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Vojnosanitetski pregled
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